13 September 2009

Just occasionally the people who are in charge read this blog. Dr Grumble has been thinking of listing for them the ways the English NHS could make enormous savings without adversely affecting patient care. You might think that our masters have no idea how they could save money and that that is why they have brought in management consultants. Reading between the lines of what some of them say (Dr Grumble is not going to embarrass any of them by putting in a link) it seems likely that quite a few of those at the top do know how money could be saved. The problem is the thought police. Both the present government and its likely replacement are heavily blinkered and there are some solutions they will not countenance. Our masters' minds have been poisoned by outside advisers with their own private agendas. The politicians either do not realise how they are being used or they are prepared to be used in order to bolster their party coffers.

In short there is no hope. Dr Grumble knows that. But whether anybody was going to listen to him or not Dr Grumble has been planning for some time to list the many painless ways the NHS in England could save money.

But happily there is no need. There is just one lone voice in the wilderness who has done the job already. This is just one of her suggestions for saving money:

Take for example the costs of the new market bureaucracy; for more than 40 years administration costs were in the order of 6% of the total budget a year, they doubled overnight to 12% in 1991 with the introduction of the internal market. We have no data today for England, but what we know from the US is that the introduction of for-profit providers increases administrative costs to the order of 30% or more.
So why hasn't McKinsey advocated making savings along the lines of Scotland and Wales by reintegrating trusts into area-based planning structures and thereby abolishing billing, invoicing, the enormous finance departments, marketing budgets and management consultants, lawyers, commercial contracts? In this way one could project savings of anything from £6-24bn a year for England.

Who is this lone voice? Find out here. She's Dr Grumble's heroine. Do you think she knows?

Posted by
Dr Grumble

17 comments:

Allyson Pollock I presume. I think the best thing that happened to the Scottish NHS was her taking up a professorship at Edinburgh Uni; by contrast, the worst thing that has happened to England was her leaving. You guys seem to be floating further and further away from us. I can see a situation where Scotland, Wales and N. Ireland have an NHS, and England doesn't.Sorry to be so gloomy. Here's some alternative suggestions on how to save money in the NHS to cheer you up;http://juliemcanulty.blogspot.com/2009/09/how-to-save-money-on-nhs-managers.html

Snap!!!Unfortunately the chances of England NHS being privatized in a disguised format is very high as so many of the Labour MPs are scrambling for their next job. This government has employed the most so called consultants and often as a way of securing themselves a job just in case. Now it is not even ”just in case”. I know someone who has only a couple of O-levels was employed at the one of the big government institution as a consultant although her fees are small (only £1200/day) but it was for over a year. All she did was Power Point prep for the big shots. Just look at the ex-FSA head. (Guardian: John Tiner once had a reputation for being the luckiest man in the City. Without a university degree, he worked his way up to the top of accountant Arthur Andersen - and left nine months before it collapsed under the weight of fraud and false accounting at its client Enron.)Where is he now? Just Google him.

Even though I have lived in the UK outside England and I see the problems of being distant from London, I used never to be much in favour of devolution. I rather assumed that politicians everywhere would make the same wrong decisions. But that has not turned out to be the case. Scotland and Wales seem to be making better decisions for the NHS than London is for England. I am even beginning to wonder whether devolved government for the English regions might be a good thing though the public has shown little enthusiasm for this.

Why should this be? Why are things seen differently in Scotland, Wales and Northern Ireland? Are we really that different? Perhaps we are. There are historical differences in the provision of education and healthcare. And you could say the NHS was spawned in Wales.

My feeling is that some of the problems stem from our government being located in London. London has special healthcare problems which has made the London NHS look weak. The very rich, who care little about the NHS, live alongside the poor who have no voice. And, perhaps most important of all, there are a lot of powerful people leaning on our political masters causing the policies of the two main parties to converge to such an extent that you get the impression that both are hell-bent on a private solution to what they see as the problems of the NHS.

It is a strange irony that both the party leaders as a result of unfortunate personal experiences bear witness to the true value of the NHS. But I agree that unless there is a public backlash the NHS in England looks doomed.

Hello!!!It is the selfishness of people that is causing the problem. It used to be that Insurance is a sort of Community spirited as not everybody would have a car accident or be injured accidentally. It is altruistic to chip in so that the unfortunate few can get compensated.

Then the crooks moved in. They burn their failing business to claim insurance, some killed their wives to claim life insurance.

The NHS was started on that spirit although before then the teaching hospitals treated the poor for free in return for their being used for teaching.

Then the rich wanted to jump the queue and get health insurance to do that. Then those in charge realised that there is big money to be made. Instead of burning the NHS, you collapse it one way or another.

The masses cannot see this as Ibsen pointed out ages ago in Enemy of the People. The minority as it turned out may sometimes be right.

It is all too late as they are waiting in the wings: Patricia Hewitt: now with Cinven (Bupa Hospitals) Simon Stevens: now with UnitedHealthThe minority must now speak up.

Think I've said this before here, but I think the difference between England and the rest of the UK is proportional representation. This means that no one party has the majority in Parliament and it also means that the NHS can find a voice in Parliament. The election of Dr Jean Turner in 2003 was a vital factor I believe in curbing the worse excesses of Labour on the privatisation front; in a hung parliament, one vote could be vital. It also had an impact locally; in Livingston, three independent councillors got elected on a 'Save St John's Hospital' platform. In short, PR allows the popular voice to be heard. I think you guys need to hope for a hung Parliament at the next election. You might get one.

One problem though is that the public, as the Cockroach Catcher has pointed out, do not actually realise that they have a problem. Of course they will wake up when hospitals are closed but that too is a problem because the public never wants any hospital to close - even if it is the right thing to do. Often it can be. My local hospital is a sticking plaster station. There is no way I want to go there if I am really ill. But the locals won't allow it to be closed.

I am fairly certain that politicians hope that market forces will rationalise the hospital service by causing some hospitals to wither on the vine. In reality politicians will never be able to hide behind the market. And it is not at all clear that the market can decide these things in a better way than planners.

Alyson Pollock is a well;known apologist for the NHS and her views appeal to the Guardianistas. I prefer to listen to what Professor Nick Bosanquet, an economist, has to say. His 2007 article couldn't put it any better:

I read the article. The question is: if Germany is tat good, why are so many of their doctors coming to the UK. 3500 last year. Why are EU countries not transparent about their doctors being struck off. Remember Ubani anyone?

The question is: if Germany is tat good, why are so many of their doctors coming to the UK. 3500 last year. Why are EU countries not transparent about their doctors being struck off. Remember Ubani anyone?

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So you tell me why these German doctors are coming here, anonymous? In what respect is the German health service worse than the NHS? The Urbani case was a condemnation of the NHS out of hours service which, as you will recall, was "sold" by GP practices for a ridiculously low price.

If German Health Care is that good, why did they still allow Ubani to practice there despite being suspended by the GMC? In fact there are a number of Dutch doctors here too. We do not talk about the previous Eastern Bloc countries.

The part private system in Germany allowed the wealthier to jump the queue, that is all. Premium is often too high for older retired people.

We could have a better NHS if all members of GMC, government (MPS and Civil Servants and those in the nationalised banks) are not allowed to have private health insurance. Then we are going to have a better NHS. Market is what kills the NHS England (Not The other parts of the Un-united Kingdom)

Ah, dear old think tank Reform. Slightly right of Ghengis Khan, or Gengis McCann as we call him up here. David,I'm sorry, but he doesn't have a clue what he's talking about. We've had independent sector treatment centres and they have been an expensive failure. Up here we had Stracathro, for hip and knee operations. Government paid them £15 million in advance for a set number of operations, regardless of whether they did the operations or not. Then Netcare turned round and said that they couldn't do operations that involved a 'risk'. As most of those getting hip and knee operations tend to be over 60 with co-morbidities, this meant that Stracathro was having difficulty getting above 70% occupancy; at one point it was 50%. The SNP bailed out of this, this year; Netcare have made themselves a nice wee profit and we are sitting with a whole lot of people who weren't able to access their services. Total waste. I could go on about fundholding, which doubled the NHS's administration costs from 6% to 12% because of the paper trail it produced. I could tell you about PFI and how we have created a new national debt just because government wanted to keep hospitals off the public spend sheet. I could talk about in-house contractors who charge £300 to change a lightswitch, or the obscene profits made from re-financing PFI loans, which do not get passed on to the NHS. And I could laugh at Nick bosanquet's statement that we could get an excellent NHS for 9-10% of the GDP. He obviously thinks that we're spending more than that on the NHS. We are actually spending 8.5% of our GDP on the NHS just now, one of the lowest outlays in Europe. This article is poorly researched and frankly I'm surprised the Telegraph printed it, but it shows the widespread ignorance about the NHS that the Telegraph can print something like this and get away with it. Depressing.